Medicare is Australia’s universal health insurance scheme that subsides the costs of medical services, tests and scans. It is a complex system with 1000s of potential items that can be billed. However, as a GP registrar you will only need to know a portion of these.
MBS At A Glance
The items you will most commonly use are the ‘general attendance’ items. These are a series of items based on how long the appointment with the patient lasts and where the appointment takes place. See the table below for useful item numbers.
There are some general principles to be aware of:
- The time-tiers for these items range from a “Level A” for straightforward tasks (less than 6 minutes) to “Level E” consultations (60+ minutes).
- General attendance items should be claimed when no other MBS item applies. This means that where a more specific MBS item exists (for example a skin biopsy under MBS item 30071), the more specific item should be claimed.
- All general attendance items can be claimed to address multiple issues with a patient (unless, another more specific MBS item applies).
- Only time spent with the patient (or on the telephone/video call with the patient) performing clinically relevant tasks can be included in the consultation time. For example, writing notes or talking to carers without the patient, do not count as consultation time.
- If it takes longer to ensure good communication with the patient (eg. using a translator, or the patient has dementia) then all the time with the patient does count towards the consultation time.
- It is possible to claim two items for the one session with the patient (ie. to “co-claim”) but, to claim both the general attendance item and another item, both services must be clinically relevant and distinct services. And there are some specific restrictions to this (eg. general attendance and chronic disease management items cannot be co-claimed).
Learning the MBS often feels like a steep-learning curve for new GP registrars. Always discuss with your GP supervisor if you are uncertain.
General information on the MBS is available at www.mbsonline.gov.au
MBS is available at www.mbsonline.gov.au
Level A Straightforward |
Level B 6-20 minutes |
Level C 20+ minutes |
Level D 40+ minutes |
Level E 60+ minutes |
|
---|---|---|---|---|---|
Business hours | |||||
In consulting rooms | 3 | 23 | 36 | 44 | 123 |
Out of consulting rooms | 4 | 24 | 37 | 47 | 124 |
RACF¹ | 90020 | 90035 | 90043 | 90051 | 90054 |
After-hours | |||||
In consulting rooms² | 5000 | 5020 | 5040 | 5060 | 5071 |
Out of consulting rooms² | 5003 | 5023 | 5043 | 5063 | 5076 |
RACF³ | 5010 | 5028 | 5049 | 5067 | 5077 |
Telehealth | |||||
Telehealth (video) | 91790 | 91800 | 91801 | 91802 | 91920 |
Telephone | 91890 | 91891 | 91900⁴ | 919104 | NA |
This table and the principles above are adapted from https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23
By Dr Daniel Mogg (GPRA Medical Education & Training Advisor)